You don't need a masterpiece to get the idea. -- Pablo Picasso In 1977 I wrote the first edition of Cultural Diversity in Health and Illness and have revised it several times since then; this is the sixth edition. The purpose of each edition has been to increase the reader's awareness of the dimensions and complexities involved in caring for people from diverse cultural backgrounds. I wished to share my personal experiences and thoughts concerning the introduction of cultural concepts into the education of health care professionals. The books represented my answers to the questions: "How does one effectively expose a student to cultural diversity?" "How does one examine health care issues and perceptions from a broad social viewpoint?" As I had done in the classroom, I attempted to bring the reader into direct contact with the interaction between providers of care within the North American health care system and the consumers of health care. The staggering issues of health care delivery are explored and contrasted with the choices that people may make in attempting to deal with health care issues. It is now imperative, according to the most recent policies of the Joint Commission of Hospital Accreditation and the Centers for Medicare & Medicaid Services, that all health care providers be culturally competent. In this context, cultural competence implies that within the delivery of care the health care provider understands and attends to the total context of the patient's situation; it is a complex combination of knowledge, attitudes, and skills. Yet, How do you really inspire people to hear the content? How do you motivate providers to see the worldview and lived experience of the patient? How do you assist providers to really bear witness to the living conditions and life ways of patients? How do you liberate providers from the burdens of prejudice, xenophobia, the "isms"--racism, ethnocentrism--and the "antis"? It can be argued that the development of cultural competency does not occur in a short encounter with cultural diversity; but that it takes time to develop the skills, knowledge, and attitudes to safely and satisfactorily deliver CulturalCare. Features Free Companion Web site at www.prenhall.com/spector with activities, fill-in-the-blanks, multiple choice questions, web links, and more. Online Course Management Systems.Also available are online companions for schools using course management systems. For more information about adopting an online course management system to accompany Cultural Diversity in Health and Illness, Sixth Edition please contact your Prentice Hall Health Sales Representative www.prenhall.com/mischtm/rep-locator-fr.html or go to the appropriate websites at cms.prenhall.com/webct/index.html or cms.prenhall.com/blackboard/index.html or cms.prenhall.com/coursecompass Health Traditions Imagery.This edition of the book uses symbolic images to create the linkages from chapter to chapter. The HEALTH (HEALTH, when written this way, is defined as the balance of the person, both within one's being-physical, mental, spiritual-and in the outside world-natural, familial and communal, metaphysical) images were selected to awaken you to the richness of a given heritage and the HEALTH/health beliefs, and practices inherent within both modern and traditional cultures. Guidelines for Developing Cultural Competency.A "map" that passes from broad and general dimensions of health and illness to specific images of traditional HEALTH beliefs and practices; at the personal level, the modern health care delivery level, and within traditional dimensions. Three developmental dimensions: Cultural Foundations--an overview of cultural heritage and history that serves to illustrate the underlying concepts inherent in the diversity within our society, and basic elements of health and illness. Domains of HEALTH--the worlds of the provider and patient as reflected in broad and general HEALTH and HEALING from a personal perspective to the perspectives of socialization into the allopathic philosophy and health care delivery system. Panoramas of HEALTH--the worlds of traditional HEALTH beliefs and practices among selected populations. Historical Perspectives.An overview of historic sociocultural, public health, and health policy events and medical milestones from 1900 to 2003. OVERVIEW Unit I focuses on the background knowledge one must recognize as the foundation for developing cultural competency. Chapter 1 explores the concept of cultural heritage and history and the roles they play in one's perception of health and illness. This exploration is first outlined in general terms: What is culture? How is it transmitted? What is ethnicity? What is religion? How do they affect a given person's health? What major sociocultural events occurred during the life trajectory of a given person that may influence their personal health beliefs and practices? Chapter 2 presents a discussion of the diversity--demographic, immigration, and poverty--that impacts on the delivery of and access to health care. The backgrounds of each of the U.S. Census Bureau's categories of the population, an overview of immigration, and an overview of issues relevant to poverty are presented. Chapter 3 reviews the provider's knowledge of his or her own perceptions, needs, and understanding of health and illness. Unit II explores the domains of HEALTH, blends them with one's personal heritage, and contrasts them with allopathic philosophy. Chapter 4 introduces the concept of HEALTH and develops the concept in broad and general terms. The HEALTH Traditions Model is presented, as are natural methods of HEALTH restoration. Chapter 5 explores the concept of HEALING and the role that faith plays in the context of HEALING, or magico-religious, traditions. This is an increasingly important issue, which is evolving to a point where the health care provider must have some understanding of this phenomenon. Chapter 6 discusses family heritage and explores personal and familial HEALTH traditions. It includes an array of familial health beliefs and practices shared by people from many different heritages. Chapter 7 focuses on the allopathic health care delivery system and the health care provider culture. Once the study of each of these components has been completed, Unit III moves on to explore selected population groups in more detail, to portray a panorama of traditional HEALTH and ILLNESS beliefs and practices, and present relevant health care issues. These pages can neither do full justice to the richness of any one culture nor any one health-belief system. By presenting some of the beliefs and practices and suggesting background reading, however, the book can begin to inform and sensitize the reader to the needs of a given group of people. It can also serve as a model as to how to develop cultural knowledge in populations that are not included. The Epilogue is devoted to an overall analysis of the book's contents and how best to apply this knowledge in health care delivery, health planning, and health education, for both the patient and the health care professional. There is so much to be learned. Countless books and articles have now appeared that address these problems and issues. It is not easy to alter attitudes and beliefs or stereotypes and prejudices. Some social psychologists state that it is almost impossible to lose all of one's prejudices, yet alterations can be made. I believe the health care provider must develop the ability to deliver CulturalCare and a sensitivity to personal fundamental values regarding health and illness. With acceptance of one's own values comes the framework and courage to accept the existence of differing values. This process of realization and acceptance can enable the health care provider to be instrumental in meeting the needs of the consumer in a collaborative, safe, and professional manner. The first edition of this book was the outcome of a promesa --a promise--once made. The promise was made to a group of Black and Hispanic students I taught in a medical sociology course in 1973. In this course, the students wound up being the teachers, and they taught me to see the world of health care delivery through the eyes of the health care consumer rather than through my own well-intentioned eyes. What I came to see I did not always like. I did not realize how much I did not know; I believed I knew a lot. I have held on to the promesa, and my experiences over the years have been incredible. I have met people and traveled. At all times I have held on to the idea and goal of attempting to help nurses and other providers be aware of and sensitive to the beliefs and needs of their patients. I know that looking inside closed doors carries with it a risk. I know that people prefer to think that our society is a melting pot and that old beliefs and practices have vanished with an expected assimilation into mainstream North American life. Many people, however, have continued to carry on the traditional customs and culture from their native lands, and health and illness beliefs are deeply entwined within the cultural and social beliefs that people have. To understand health and illness beliefs and practices, it is necessary to see each person in his or her unique sociocultural world. The shattering events of September 11, 2001, represent in many ways the clarion call for all of us to wake up and hear and listen to the voices of all people. Indeed, the events are symptomatic of Global Polarization in such conflicts as: Traditionalism vs. Modernism Fundamentalism vs. Universalism Heritage vs. Secular Minimalism vs. Excessism Self-Denialism vs. Materialism Fatalism vs. Determinism Allopathy vs. Homeopathy Curing vs. HEALING Global Polarization is culturally based and seems to be the engine driving recent events. It is an attempt to look at the big picture that encompasses health care and attempts to find cultural meaning in daily life. In our world, that of health care delivery, it mandates that we must develop the knowledge and skills of CulturalCare. This book is written primarily for the student in basic allied health professional programs, nursing, medical, social work, and other health care provider disciplines. I believe it will be helpful also for providers in all areas of practice, especially community health, long-term oncology, chronic care settings, and geriatric and hospice centers. I am attempting to write in a direct manner and to use language that is understandable by all. The material is sensitive, yet I believe that it is presented in a sensitive manner. At no point is my intent to create a vehicle for stereotyping. I know that one person will read this book and nod "Yes, this is how I see it," and someone else of the same background will say "No, this is not correct." This is the way it is meant to be. It is incomplete by intent. It is written in the spirit of open inquiry, so that an issue may be raised and so that clarification of any given point will be sought from the patient as health care is provided. The deeper I travel into this world of cultural diversity, the more I wonder at the variety. It is wonderfully exciting. By gaining insight into the traditional attitudes that people have toward health and health care, I find my own nursing practice is enhanced, and I am better able to understand the needs of patients and their families. It is thrilling to be able to meet, to know, and to provide care to people from all over the world. It is the excitement of nursing. As we now go forward in time, I hope that these words will help you, the reader, develop CulturalCare skills and help you to provide the best care to all. Excerpted from Cultural Diversity in Health and Illness by Rachel E. Spector All rights reserved by the original copyright owners. Excerpts are provided for display purposes only and may not be reproduced, reprinted or distributed without the written permission of the publisher.
